Post-Survey Assistive Technology

We are interested in hearing about your experience with Assistive technology.

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* 1. What kind of Assistive Technology did you use? (check all that apply)

Software

Tablet or computer

Smart Home equipment

Remote Assistance

Other_

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* 2. I requested the above technology item(s) to improve my ability to communicate

Yes

No

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* 3. My Technology Item helped me improve my ability to communicate:

	Very Much	A little bit	Not at all	N/A
With my care providers	With my care providers Very Much	With my care providers A little bit	With my care providers Not at all	With my care providers N/A
With my friends	With my friends Very Much	With my friends A little bit	With my friends Not at all	With my friends N/A
When I needed help	When I needed help Very Much	When I needed help A little bit	When I needed help Not at all	When I needed help N/A

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* 4. I requested the above technology item(s) to improve my health and safety

Yes

No

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* 5. My Technology Item helped me improve my my health and safety:

	Very Much	A little bit	Not at all	N/A
In an emergency	In an emergency Very Much	In an emergency A little bit	In an emergency Not at all	In an emergency N/A
In my home	In my home Very Much	In my home A little bit	In my home Not at all	In my home N/A
When I needed remote help in the community	When I needed remote help in the community Very Much	When I needed remote help in the community A little bit	When I needed remote help in the community Not at all	When I needed remote help in the community N/A

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* 6. I requested the above technology item(s) to increase my independence

Yes

No

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* 7. My Technology Item helped me to be more independent:

	Very much	A little bit	Not at all	N/A
By helping me learn to manage my money	By helping me learn to manage my money Very much	By helping me learn to manage my money A little bit	By helping me learn to manage my money Not at all	By helping me learn to manage my money N/A
By helping manage daily tasks	By helping manage daily tasks Very much	By helping manage daily tasks A little bit	By helping manage daily tasks Not at all	By helping manage daily tasks N/A
By helping me track or manage my schedule	By helping me track or manage my schedule Very much	By helping me track or manage my schedule A little bit	By helping me track or manage my schedule Not at all	By helping me track or manage my schedule N/A

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* 8. Other ways my technology helped me (please describe below)